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https://www.readbyqxmd.com/read/29135772/can-composite-measures-provide-a-different-perspective-on-provider-performance-than-individual-measures
#1
Michael Shwartz, Amy K Rosen, James F Burgess
BACKGROUND: Composite measures, which aggregate performance on individual measures into a summary score, are increasingly being used to evaluate facility performance. There is little understanding of the unique perspective that composite measures provide. OBJECTIVE: To examine whether high/low (ie, high or low) performers on a composite measures are also high/low performers on most of the individual measures that comprise the composite. METHODS: We used data from 2 previous studies, one involving 5 measures from 632 hospitals and one involving 28 measures from 112 Veterans Health Administration (VA) nursing homes; and new data on hospital readmissions for 3 conditions from 131 VA hospitals...
December 2017: Medical Care
https://www.readbyqxmd.com/read/29131696/risk-factors-for-discontinuation-of-treatment-for-neovascular-age-related-macular-degeneration
#2
Inger Westborg, Aldana Rosso
PURPOSE: To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD). METHODS: Data from the Swedish Macula Register and the Skåne Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013-2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10-14 months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree...
November 13, 2017: Ophthalmic Epidemiology
https://www.readbyqxmd.com/read/29129499/d-dimer-predicts-bleeding-complication-in-out-of-hospital-cardiac-arrest-resuscitated-with-extracorporeal-membrane-oxygenation
#3
Takayuki Otani, Hirotaka Sawano, Tomoaki Natsukawa, Reiko Matsuoka, Tetsufumi Nakashima, Motonori Takahagi, Yasuyuki Hayashi
PURPOSE: In out-of-hospital cardiac arrest (OHCA) patients resuscitated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), known as extracorporeal cardiopulmonary resuscitation (ECPR), bleeding is a common complication. The purpose of this study was to assess the risk factors for bleeding complications in ECPR patients. METHODS: We retrospectively analyzed the data for OHCA patients admitted to our hospital and resuscitated with ECPR between October 2009 and December 2016...
November 8, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29126895/extracorporeal-membrane-oxygenation-in-circulatory-and-respiratory-failure-a-single-center-experience
#4
Marisa Passos Silva, Daniel Caeiro, Paula Fernandes, Cláudio Guerreiro, Eduardo Vilela, Marta Ponte, Adelaide Dias, Fernando Alves, Jorge Morais, Andreza Mello, Lino Santos, Paula Castelões, Vasco Gama
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) provides mechanical pulmonary and circulatory support for patients with shock refractory to conventional medical therapy. In this study we aim to describe the indications, clinical characteristics, complications and mortality associated with use of ECMO in a single tertiary hospital. METHODS: We conducted a retrospective observational cohort study of all patients supported with ECMO in two different intensive care units (general and cardiac), from the first patient cannulated in April 2011 up to October 2016...
November 7, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29111340/agenesis-of-the-left-internal-carotid-artery-associated-with-dolichoectatic-intracranial-arteries
#5
Motohiro Nomura, Akira Tamase, Kentaro Mori, Syunsuke Seki, Yu Iida, Yuichi Kawabata, Tatsu Nakano
A 28-year-old man without a significant medical history visited our hospital complaining of a headache. Computed tomography (CT) demonstrated thick, calcified vertebral artery (VA) and basilar artery (BA), despite the patient being young. Magnetic resonance angiography demonstrated the absence of the left internal carotid artery (ICA). The right ICA, the bilateral VA, and the BA were well developed and dolichoectatic. CT revealed the absence of the carotid canal on the left side. The condition was diagnosed as congenital agenesis of the left ICA with dolichoectatic changes in 3 other arteries...
October 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29107436/the-collateral-circulation-in-moyamoya-disease-a-single-center-experience-in-140-pediatric-patients
#6
Meng Zhao, Dong Zhang, Shuo Wang, Yan Zhang, Xiaofeng Deng, Jizong Zhao
BACKGROUND: The patterns and clinical significance of the presence of collaterals in moyamoya disease has not been elucidated thoroughly. We aimed to summarize the clinical features of collaterals in pediatric moyamoya disease. BASIC PROCEDURES: We reviewed consecutive pediatric patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015. Only pediatric moyamoya patients with digital subtraction angiography examinations were included in this study...
September 14, 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/29100590/anemia-and-the-risk-of-life-threatening-ventricular-tachyarrhythmias-from-the-israeli-implantable-cardioverter-defibrillator-registry
#7
Ido Goldenberg, Alon Barsheshet, Avishag Laish-Farkash, Moshe Swissa, Jorge E Schliamser, Yoav Michowitz, Michael Glikson, Mahmoud Suleiman
Anemia was shown to be associated with increased risk for adverse events in patients with heart failure (HF). However, there are limited data on the association between anemia and the risk for ventricular arrhythmias (VAs) in patients with an implantable cardioverter defibrillator (ICD). The present study population comprised 2,352 patients who were enrolled and prospectively followed up in the Israeli ICD Registry. The risk for a first appropriate ICD shock for VA was assessed by the presence of anemia, categorized at the lower tertile of hemoglobin distribution (≤12 g/dL [n = 753])...
October 5, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29091252/difficulties-of-distal-catheter-insertion-of-ventriculoatrial-shunting-in-infants-and-little-children
#8
Hakan Erdogan, Adnan Altun, Enis Kuruoglu, Ahmet Hilmi Kaya, Adnan Dagcinar
AIM: Ventriculoatrial (VA) shunting is a well-described cerebrospinal fluid diversion method for the treatment of hydrocephalus. However, it may be very challenging in infants and little children because of atrial catheter placement difficulties. This study aimed to create an algorithm to solve problems faced during open surgical procedures based on the present authors' experience. MATERIAL AND METHODS: We conducted a retrospective analysis on 18 infants and children who underwent VA shunt insertion at the Department of Neurosurgery, Ondokuz Mayıs University School of Medicine Hospital between 2005 and 2012...
September 26, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/29084123/a-survey-of-prescribers-attitudes-knowledge-comfort-and-fear-of-consequences-related-to-an-opioid-overdose-education-and-naloxone-distribution-program
#9
Alyssa M Peckham, Maria E Niculete, Howard Steinberg, Douglas L Boggs
CONTEXT: The alarming increase in opioid-related fatalities has placed the United States in the midst of an opioid epidemic. In an effort to reduce opioid-related fatalities, each Veterans Affairs (VA) hospital is responsible for development of an OEND (Overdose Education and Naloxone Distribution) program to enhance naloxone distribution. OBJECTIVE: To assess attitudes, knowledge, comfort level, and fear of consequences at the prescriber level related to the OEND program at VA Connecticut Healthcare System (VACHS)...
October 27, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/29081472/early-prediction-model-for-successful-bridge-to-recovery-in-patients-with-fulminant-myocarditis-supported-with-percutaneous-venoarterial-extracorporeal-membrane-oxygenation%C3%A3-insights-from-the-change-pump-study
#10
Akinori Sawamura, Takahiro Okumura, Akihiro Hirakawa, Masaaki Ito, Yukio Ozaki, Nobuyuki Ohte, Tetsuya Amano, Toyoaki Murohara
BACKGROUND: Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results:This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO...
October 27, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29079376/validation-of-the-troponin-only-manchester-acute-coronary-syndromes-decision-aid-with-a-contemporary-cardiac-troponin-i-assay
#11
Patricia Va Den Berg, Gillian Burrows, Philip Lewis, Simon Carley, Richard Body
OBJECTIVES: The Manchester Acute Coronary Syndromes (MACS) decision aid can 'rules in' and 'rule out' acute coronary syndromes (ACS) by combining a patient's symptoms with the results of a single blood test taken at the time of arrival in the Emergency Department (ED). The original model (MACS) included two biomarkers: high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (h-FABP). A refined model without h-FABP was found to have comparable sensitivity but greater specificity...
September 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29075097/areas-and-factors-associated-with-patients-dissatisfaction-with-glaucoma-care
#12
Valencia Hui Xian Foo, Sarah En Mei Tan, David Ziyou Chen, Shamira A Perera, Charumathi Sabayanagam, Eva Katie Fenwick, Tina T Wong, Ecosse L Lamoureux
OBJECTIVE: The aim of this study was to evaluate patients' dissatisfaction with overall and specific aspects of a tertiary glaucoma service and to determine their independent factors, including intraocular pressure (IOP) and visual acuity (VA). METHODS: Patients, aged ≥21 years, from a specialist glaucoma service in a tertiary eye hospital in Singapore for at least 6 months, were recruited for this cross-sectional study between March and June 2014. All consenting patients completed a 7-area glaucoma-specific satisfaction questionnaire and one item related to satisfaction with overall glaucoma care...
2017: Clinical Ophthalmology
https://www.readbyqxmd.com/read/29068439/perception-of-resources-spent-on-defensive-medicine-and-history-of-being-sued-among-hospitalists-results-from-a-national-survey
#13
Sanjay Saint, Valerie M Vaughn, Vineet Chopra, Karen E Fowler, Allen Kachalia
The United States spends substantially more per capita for healthcare than any other nation. Defensive medicine is 1 source of such spending, but its extent is unclear. Using a national survey of approximately 1500 US hospitalists, we report the estimates the US hospitalists provided of the percent of resources spent on defensive medicine and correlates of their estimates. We also ascertained how many reported being sued. Sixty-eight percent of eligible recipients responded. Overall, respondents estimated that 37...
August 23, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29063900/demographic-characteristics-and-visual-status-of-patients-undergoing-cataract-surgery-at-a-tertiary-hospital-in-kano-nigeria
#14
Musbahu Sani Kurawa, Lawan Abdu
Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. METHODS: The study adhered to the tenets of the Helsinki declaration...
October 2017: Annals of African Medicine
https://www.readbyqxmd.com/read/29061078/introducing-personalized-health-for-the-family-the-experience-of-a-single-hospital-system
#15
Kathi L Huddleston, Elisabeth Klein, Alma Fuller, Grace Jo, Grace Lawrence, Susanne B Haga
Pharmacogenetic testing is leading the personalized health movement, gradually being implemented in a variety of healthcare settings. To inform the efforts of other hospital and clinical practices implementing personalized health or medicine applications, we describe the implementation of a newborn pharmacogenetic testing program at Inova Health System (VA, USA). In particular, we describe the efforts to gather patient feedback through focus groups, the training and program staff, the pilot program and our experiences to date...
October 24, 2017: Pharmacogenomics
https://www.readbyqxmd.com/read/29059687/synopsis-of-the-2017-u-s-department-of-veterans-affairs-u-s-department-of-defense-clinical-practice-guideline-management-of-type-2-diabetes-mellitus
#16
Paul R Conlin, Jeffrey Colburn, David Aron, Rose Mary Pries, Mark P Tschanz, Leonard Pogach
Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines...
November 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29056239/short-term-exposure-to-air-pollutants-increases-the-risk-of-st-elevation-myocardial-infarction-and-of-infarct-related-ventricular-arrhythmias-and-mortality
#17
Jordi Bañeras, Ignacio Ferreira-González, Josep Ramon Marsal, José A Barrabés, Aida Ribera, Rosa Maria Lidón, Enric Domingo, Gerard Martí, David García-Dorado
BACKGROUND: The relation between STEMI and air pollution (AP) is scant. We aimed to investigate the short term association between AP and the incidence of STEMI, and STEMI-related ventricular arrhythmias (VA) and mortality. METHODS: The study was carried out in the area of Barcelona from January 2010 to December 2011. Daily STEMI rates and incidence of STEMI-related VA and mortality were obtained prospectively. The corresponding daily levels of the main pollutants were recorded as well as the atmospheric variables...
October 5, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29045064/epidemiology-and-burden-of-influenza-in-the-u-s-department-of-veterans-affairs
#18
Cynthia Lucero-Obusan, Patricia L Schirmer, Aaron Wendelboe, Gina Oda, Mark Holodniy
We describe influenza activity in the US Veterans Affairs (VA) population for the 2010-2011 through 2015-2016 seasons and compare with national CDC FluView data. VA confirmed influenza cases ranged from 1,005-11,506 per season; triage calls from 6,090-10,346; outpatient visits from 3,849-13,406; antiviral prescriptions from 3,650-32,826; hospitalizations from 546-4,673; and deaths in hospitalized patients from 17-139. Peak activity was generally the same as observed nationally by the CDC. For the seasons analyzed, correlation between VA and CDC %ILI visits (r=0...
October 16, 2017: Influenza and Other Respiratory Viruses
https://www.readbyqxmd.com/read/29040883/veno-arterial-extracorporeal-membrane-oxygenation-va-ecmo-for-emergency-cardiac-support
#19
Terri Sun, Andrew Guy, Amandeep Sidhu, Gordon Finlayson, Brian Grunau, Lillian Ding, Saida Harle, Leith Dewar, Richard Cook, Hussein D Kanji
PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. MATERIALS AND METHODS: A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest...
October 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29035775/avoiding-the-pocket-a-case-report-of-coiling-of-distal-shunt-catheter-into-subcutaneous-pocket
#20
Richard Justin Garling, Sandeep Sood, Carolyn Anne Harris
INTRODUCTION: Hydrocephalus is one of the most common disorders of neurosurgery and ventricular shunting, the primary surgical intervention, malfunctions in 85% of patients by 10 years. PRESENTATION OF CASE: Here we present a case of a 12-year-old girl with history of a vagal nerve stimulator (VNS) and ventricular shunt, most recently revised from ventriculoatrial (VA) to ventriculoperitoneal (VP) shunt at an outside hospital. The patient presented with a new left chest bulge, nausea, emesis, and seizures...
October 10, 2017: International Journal of Surgery Case Reports
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